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An educational presentation from the Year of Children’s Vision initiative

The goal of YOCV is to provide national guidance to staff of Head Start, Early Head Start and other early childhood programs to standardize approaches to vision screening,

improve follow-up for eye care, provide family friendly educational information and consult with some of the nation’s leading pediatric eye care providers to ensure best practices.

YOCV was initiated by and is supported by leading national vision health organizations, for a complete list and other resources go to: http://nationalcenter.preventblindness.org/year-childrens-vision

The goal of today’s presentation is to help program staff develop and implement a strong, 12-component Vision Health System of Care, even when vision screening is conducted by volunteers or outside agencies. This system of care includes critical questions to answer about vision development and ways parents can be engaged in follow-up care.

After this session you will be able to: 1. Describe the 12 components that support a strong Vision Health System of Care

2. Describe 3 critical components to monitor when outside volunteers screen vision of your children

3. Describe 3 critical components of your vision health program to measure annually

4. Describe 3 vision resources available from the Year of Children's Vision and the National Center for Children's Vision and Eye Health at Prevent Blindness

At the end of the day..

P. Kay Nottingham Chaplin, Ed.D

o Director - Vision and Eye Health Initiatives for The Good-Lite Company and School Health Corporation

o Member – National Advisory Committee and Education Subcommittee to the National Center for Children’s Vision and Eye Health at Prevent Blindness

Kira Baldonado, BA

o Director, National Center for Children’s Vision and Eye Health at Prevent Blindness

P. Kay Nottingham Chaplin, Ed.D

Employed by Good-Lite

Consultant to School

Health Corporation

Kira Baldonado, BA

This presenter has no

conflicts of interest to

declare. The opinions

expressed in this

presentation are solely

those of the presenter.

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1. Support Your Families

2. Employ an evidence-based approach to vision screening

3. Ensure effective communication among all stakeholders

4. Assess your competency- are you making a difference?

Each “key consideration” includes multiple components that should be attended to.

We have vision health information in all native languages of the families that we serve.

We discuss the importance of healthy vision as a part of proper child development in the general health information provided by our program.

We provide parents with easy-to-understand* information on the visual milestones for children at all stages of life.

Our parent/and or health advisory committee(s) have reviewed our vision health information for, content, clarity of instruction, cultural literacy, and reading level .

We provide health information to parents of children with special healthcare needs that describe their increased risk for vision problems.

We have active Parent and Health Advisory Committees

Share screening results with the child’s eye care provider

and primary care provider.

Receive eye exam results for our program’s records.

Talk with the child’s eye care provider for clarification of eye

exam results and prescribed treatments.

Share eye exam results with the child’s primary care

provider.

Be aware of state specific laws around health information.

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Vision screening results are provided in both a written and

verbal format to parents/caregivers.

We provide vision screening referral information and follow

up to care information in the family’s native language.

Our vision screening referral information is written at a 4th

to 6th grade reading level.

The follow-up actions for families are clearly described and

parents are advised to act within a specified timeframe.

We have an updated list of area eye care providers who

serve children.

We provide access to programs for free or low cost vision

services.

We create opportunities for local eye care providers to

speak with all families we serve.

We facilitate families’ access to health insurance coverage

for which their child may qualify.

We have an eye care professional with vision screening

experience on our Health Advisory Committee.

http://nationalcenter.preventblindness.org/resources-2

Financial Assistance

Programs VS Referral

Documents

Parent Education

Two types of vision screening:

Optotype-based

Instrument-based

Or combination

Optotype = name of shape, letter, or number

to identify

Optotype-based screening measures visual acuity

Instrument-based screening measures for presence of amblyopia risk factors:

Significant refractive error

Asymmetry of refractive error

Misalignment of eyes

Presence of cataract

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If we use devices for instrument-based screening, the

devices include software upgrades recommended by the

National Center for Children’s Vision and Eye Health at

Prevent Blindness.

If we use devices, the referral criteria is set according to

recommendations from the National Center for Children’s

Vision and Eye Health at Prevent Blindness or our local eye

care providers.

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Welch Allyn SureSight

Calibrated every 18 months

Set in child mode

Set in “minus” calibration until you can

upgrade to recent software

Upgrade software to Version 2.25

PediaVision Spot

Updated with most recent software

Discuss referral criteria with local eye

care professional

Plusoptix S09, S12R, or S12C

Updated with most recent software

Discuss referral criteria with local eye

care professional

Head Start children in

Vision in Preschoolers

Study

o Could “nearly always”

participate in instrument-

based screening if unable

to participate in optotype-

based screening, and vice

versa

If we use devices, we

have an age-appropriate

and evidence-based test

of visual acuity as a

backup if:

o The device malfunctions,

o We forgot to charge the

batteries, or

o We cannot achieve a

reading.

Vision in Preschoolers Study Group. (2007). Children unable to perform screening

tests in Vision in Preschoolers Study: Proportion with ocular conditions and impact on

measure of test accuracy. Investigative Ophthalmology & Visual Science, 48(1), 83-

87. Retrieved from http://www.iovs.org/content/48/1/83.full.pdf+html

If we do optotype-based vision screening as a backup to instrument-based screening, we use an “eye chart” that meets national/international design guidelines for standardized eye charts, an approved optotype booklet, or a single, surrounded LEA Symbols booklet or system.

If we use an “eye chart” as a test of visual acuity for optotype-based screening, the eye chart meets national/international design guidelines for standardized eye charts.

Research supports using single, LEA Symbols optotypes

surrounded with bars at 5 feet for children aged 3 to 5 years

Vision in Preschoolers (VIP) Study Group. (2009). Findings from the

Vision in Preschoolers (VIP) Study. Optometry and Vision Science, 86(6),

619-623.

Optotypes approximately equal in legibility

Horizontal between-optotype spacing = 1 optotype width

Vertical between-line spacing = height of next line down

Geometric progression of optotype sizes of 0.1 log units (logMAR, ETDRS)

5 optotypes per line

Optotypes black on white background with luminance between 80 cd/m2 and 160 cd/m2

Similar recommendations across

guidelines

Design guidelines = “ETDRS Design”

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Tips: • Line outside optotypes =

inverted pyramid, NOT rectangle

• 20/32 vs. 20/30

• 10 feet vs. 20 feet

YES

NO

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Allen

Pictures

Tumbling E Kindergarten Test Chart Snellen Letters

Lighthouse

or “House,

Apple,

Umbrella”

We use appropriate occluders when screening the vision of

our children with tests of visual acuity.

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If an outside person or agency screens the vision of our

children, we have a process to review tools used.

We follow national guidelines for when to refer children.

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Example: 2003 Policy

Statement from:

• American Academy of

Pediatrics

• American Association of

Certified Orthoptists

• American Association for

Pediatric Ophthalmology

and Strabismus

• American Academy of

Ophthalmology

Ages 3-5 years:

• Majority of optotypes (3 of 5) on

20/40 line with both eyes

Ages 6 years and older

• Majority of optotypes (3 of 5) on

20/30 (20/32) line with both

eyes

Eye examination in infants, children, and young adults by

pediatricians. (2003). Pediatrics, 111(4), 902-907.

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We follow national guidelines for when to rescreen children.

If a child will not participate in screening, we make another

attempt as soon as possible, but within 6 months.

If we are unsuccessful with the first attempt at screening,

we rescreen the child immediately using a different vision

screening tool (test of visual acuity or an instrument) within

6 months.

If a child is untestable on the 2nd attempt, we refer the child

for an eye exam performed by an optometrist or an

ophthalmologist skilled in treating young children.

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Untestable children were

2x as likely to have

vision problems than

those who passed vision

screening.

If you have reason to believe that the child may perform better on another day, consider rescreening the child within 6 months.

Otherwise, refer untestable children for an eye exam with pediatric eye care professional skilled in treating young children.

Vision in Preschoolers Study Group. (2007). Children unable to perform screening tests in

Vision in Preschoolers Study: Proportion with ocular conditions and impact on measure of

test accuracy. Investigative Ophthalmology & Visual Science, 48(1), 83-87.

American Academy of Ophthalmology Pediatric Ophthalmology/Strabismus Panel. (2012).

Preferred Practice Pattern® Guidelines. Amblyopia. San Francisco, CA: American Academy of

Ophthalmology. Retrieved from http://one.aao.org/preferred-practice-pattern/amblyopia-

ppp--september-2012

We follow the National Center for Children’s Vision at Eye Health at Prevent Blindness’s vision screening training program, we receive face-to-face training from our local Prevent Blindness affiliate program, or we participate in a state-approved training program.

We ensure new staff members are formally trained within 3 months of employment through the National Center for Children’s Vision and Eye Health at Prevent Blindness, our Prevent Blindness affiliate program, or a state-approved training program.

We “refresh” training every 3 to 5 years through the National Center for Children’s Vision and Eye Health at Prevent Blindness, our local Prevent Blindness affiliate, or a state-approved training program.

We use guidelines from the National Center for Children’s Vision and Eye Health at Prevent Blindness for when to bypass vision screening and move directly to eye exam.

We have a process to indicate in a child’s files that the child met national guidelines to bypass vision screening and move directly to eye exam.

We have a professional relationship with a Teacher of the Visually Impaired (TVI) from the local school system to

answer questions about how to support the visual health of our children with special healthcare needs.

Prevent Blindness Certified Screener

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We use a reminder system to monitor

child files to determine whether we

received eye exam results from the eye

care provider.

o We use the reminder system to contact the

eye care provider if eye exam results are not

received within 1 month of the eye exam.

If eye exam results are not received

within 1 month of the eye exam, we have

a process to systematically request eye

exam results.

o If eye exam results are not received after 3

systematic contacts, we stop the process

and indicate in child files that eye exam

results could not be obtained.

If we see a pattern of challenges receiving eye exam results from

specific eye care providers, we contact the eye care provider to brainstorm ways to make it easier to receive eye exam results.

We can report outcome data on completed

referrals.

We have a system in place to send (mail, fax, e-mail) a copy of eye exam results to children’s primary care providers.

We indicate in child files the date eye exam results went to children’s primary care providers.

We indicate in child’s file if we cannot obtain a copy of eye exam results to send to child’s primary care provider.

We contact a child’s eye care provider if we do not understand the eye exam results or treatment plan.

We review vision treatment plans quarterly to help ensure parents schedule and attend upcoming eye care provider follow-up visits.

We have a process for contacting the parent if a child does not wear prescribed glasses or a patch.

We have a process for alerting a child’s eye care provider if the child does not wear prescribed glasses or a patch.

We have resources to

share with parents if their

children refuse to wear

prescribed glasses.

We conduct a sensitive

child- and family-centered

assessment to identify

barriers to following the

prescribed vision

treatment plan.

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http://nationalcenter.preventblindness.org/resources-2

Tips for Wearing Eye

Glasses VS Referral

Documents

The Eye Patch Club

We conduct follow-up calls to families within a set time* after a vision screening referral.

We provide electronic reminders (text or email).

We require a copy of a report from a primary care or eye

care provider.

We provide vision accommodations for children with a diagnosed vision problem.

We provide a parent peer-to-peer health support program to families.

We have treatment plans for vision in place for children who have been prescribed care by an eye care provider.

We compare screening results to eye exam outcomes.

We ensure that the certifications for all trained vision

screeners are current.

We review all vision screening tools annually to ensure they

are in good working order and updated.

We review our vision health program results annually with

our parent and health advisory committees.

We report our end-of-year data to health, education, and

community stakeholders.

www.familyvoices.org

http://www.fv-ncfpp.org/

http://nationalcenter.preventblindness.org/resources-2

National Center for Medical Home Implementation

http://www.medicalhomeinfo.org/

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To provide the best vision health program possible, remember that screening vision is only 1 piece.

Download – and implement - the 12 Components of a Strong Vision Health System of Care.

o http://nationalcenter.preventblindness.org/sites/default/files/national/documents/12_component_vision_health_system_of_care%20%282%29.pdf

Evaluate your program.

Develop an Action Plan for finding children like Madison..

Be on the lookout for more Year of Children’s Vision resources:

YOCV website: http://nationalcenter.preventblindness.org/year-childrens-vision

Thank you for attending!

P. Kay Nottingham Chaplin, Ed.D

kay@good-lite.com 304-376-9988

Kira Baldonado

kbaldonado@preventblindness.org

312-363-6038